Diclofenac Topical Gel for Stage IV Sacral Pressure Ulcer Pain

Case Diagnosis: The use of diclofenac topical gel for sacral ulcer wound pain over opioids.

Case Description or Program Description: 49-year-old male with sepsis, critical illness myopathy, and prolonged hospitalization presented with Stage IV sacral pressure ulcer at the inpatient rehabilitation hospital. On physical examination patient had 3 x 5 centimeter sacral wound. Patient complained of 8/10 sacral ulcer wound and bone pain and 10/10 pain on visual analog scale with dressing change. Patient was reluctant to take opioids for pain management and acetaminophen had a minimal effect.

Setting: Acute Inpatient Rehabilitation Hospital

Assessment/Results: The patient was administered diclofenac 1% topical gel 2 grams three times a day around the sacral wound and sacral bony prominence. Within 1-2 hours the patient’s pain improved to a 3/10 pain. Patient was able to tolerate sitting on the wheelchair and participate in daily therapy. The patient continued with the diclofenac topical treatment without taking other pain medications and was discharge home with diclofenac topical.

Discussion (relevance): Pressure ulcer pain is the most common symptom reported in the pressure ulcer population. Management includes pressure relief, positioning, wound care, and pain medications. Topical lidocaine is used for pressure ulcer pain, and for severe cases topical morphine is sometimes administered. Diclofenac topical gel is used to treat join pain and in one study it is effective for excisional wound pain. However, administration of diclofenac topical to pressure ulcer wound pain has never been reported. To our knowledge this is the first reported case to demonstrate effectiveness and tolerance of diclofenac topical for sacral pressure ulcer pain.

Conclusions: This is the first reported case, to our knowledge, of diclofenac topical for the treatment of pressure ulcer pain.